Reduction of transfusion requirements in pediatric craniosynostosis surgery by a new local hemostatic agent

Abstract

Background and objectives: Craniosynostosis surgery is often associated with severe perioperative bleeding especially due to venae emissariae, resulting in large transfusion amounts of packed red blood cells (PRBCs). Blood loss from venae emissariae is usually reduced by the usage of bone wax. SeraSeal is a new hemostatic agent which might help to reduce transfusion amounts if used additionally to bone wax.

Materials and methods: This study was designed with a retrospective control group (23 children), treated only with bone wax and a consecutive prospective verum group (12 children) treated additionally with SeraSeal. All children solely suffered from non-syndromic craniosynostosis, and were all treated by the same surgeons. Primary outcome variable was the volume of PRBC transfused during surgery.

Results: The numbers of PRBC transfusion was reduced significantly during the intraoperative period in the SeraSeal group (-44.5%, p < 0.05) and also during the combination of the postoperative and intraoperative period (-59.3%, p < 0.05).

Conclusion: Our analysis suggests that SeraSeal has a strong potential to reduce transfusion requirements in pediatric craniosynostosis surgery. However, we acknowledge that due to small numbers our trial can only be seen as hypothesis generating pilot study. We suggest that the effect of SeraSeal should be assessed prospectively in other studies.

Keywords: Craniosynostosis; Patient Blood Management; RBC transfusion; SeraSeal; Topical hemostasis; Transfusion.